Infertility and Tricare

For those of you with Tricare, I am curious about your experience with this type of insurance. I never realized how challenging it could be to get help and could barely find any resources!

In 2013, after discovering I had endometriosis (the culprit to my infertility), I let the OBGYN know that I had been trying for at least 8 months and could not get pregnant. She recommended I get a laparoscopy, fertility testing, and that my husband also get tested immediately to make sure he did not have any issues either. At the time, I was out of state, so she could not treat me. I returned to California, received a referral for outside care, and was later referred to a fertility specialist.

My husband requested the semen analysis and blood work recommended by the fertility specialist, but his PCM made it difficult for him to get the tests. In fact, he was told the day you walk into the clinic to report infertility is the day it is recorded as “day 1.” This means that if you were trying for a year, they will not acknowledge it. You will have to wait a year from when it is documented to get help. I had 8 months TTC in my record, but little did I know it should have been added to his too.

Nothing my husband said mattered. In fact, it didn’t even matter when we brought the paperwork from the fertility specialist to the clinic, stating that it is a legit request. The PCM said my husband did not need it. I’m glad we didn’t have the same PCM or else I would’ve been in trouble too!

Approximately 7 months after first being diagnosed with endometriosis, I finally received the laparoscopy I needed to remove the endometriomas. It was a very lengthy process to go through, but being referred to a fertility specialist was the best thing that could have happened. Our specialist was extremely knowledgeable and highly skilled. I was told that if I couldn’t get pregnant within 6 months, I should return for fertility treatments, but I was fortunate to get pregnant soon after my surgery.

If you are younger than 35, many OBGYNs recommend waiting a year before seeking help, but I would NOT recommend this with Tricare.

Also, like most insurance companies, the cost of fertility treatments such as IVF are not covered. However, tests that will help you find out the cause of your infertility are paid for. But if you have Tricare and your PCM doesn’t approve of you getting any testing done, this will only lengthen the process and possibly force you to pay out of pocket.

Good luck to all of you who are going through this process now. I hope you receive the care you deserve.

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